The Fear of Fear

By Michele Bloomquist
WebMD Feature

March 5, 2001 -- John was on a plane from Tampa to Washington, D.C., when his first panic attack hit. He began to sweat, felt queasy, and couldn't sit still. Thinking he had the flu, he left his seat and paced the aisles the entire flight. The next day, the then 23-year-old public relations manager for an NHL hockey team went to the hospital, but doctors could find nothing wrong.

A few weeks later, on a trip to Vancouver, the same symptoms hit John in his hotel room, only more intense. All night he paced, sick to his stomach, sweating, anxious, confused. The next morning he couldn't leave the hotel room. His parents suggested it might be more than the flu. He made an appointment with a psychiatrist, who diagnosed the episodes as panic attacks and placed him on the antianxiety medication Paxil.

The fear of fear

While John's (he asked that his full name not be used) condition is not unusual, the fact that he got treatment so quickly is not the norm. Every year in the United States, about three million people experience panic attacks, says Lorna Weinstock, MSW, a psychotherapist in private practice and co-author of the book Overcoming Panic Disorder: A Woman's Guide. Some will have a single episode, while others will go on to develop panic disorder, a condition that is characterized by repeated panic attacks and the constant fear that more will occur. New medications, as well as cognitive and behavioral therapy, can bring relief to as many as 90% of patients. But despite the advances in treatment, many people don't get help for months, or even years.

Mary Guardino suffered from panic attacks and depression for more than 25 years before finding a doctor who diagnosed and treated her symptoms. "I started having panic attacks as an adolescent," she tells WebMD. "But at that time, things were different. You weren't called mentally ill, you were called crazy. I was afraid I'd be put in an institution." So she hid her condition, rarely leaving her home. She wouldn't drive or go out in public alone. Her world became smaller and smaller with each panic attack.

Then in 1982 she learned that her aunt, who also rarely left the house, had gone on a trip to Europe. She contacted her aunt's new doctor, who soon diagnosed Guardino's panic and depression, put her on medication, and used cognitive and behavioral therapy to help her face her many phobias. Within a year, fear's grip was broken. Passionate to help others, Guardino set up a local support group; today, the national nonprofit mental-health advocacy association she founded, Freedom from Fear, helps thousands of others with anxiety disorders.

Recognizing panic

Like John and Guardino, most of those with panic attacks begin to experience them in their teens or early 20s, says Jerilyn Ross, MA, LICSW, president and chief executive of Anxiety Disorders of America, and author of the book Triumph Over Fear. Panic attacks rarely occur for the first time after age 40, usually in combination with a physical illness. Ross says the terror felt during a panic attack is the same physical and emotional response one would have if faced with a life-threatening situation, such as an assault, except there is no life-threatening event.

Symptoms can include rapid heartbeat, sweaty palms, trembling, trouble breathing, stomach upset, chest pains, dizziness, and the fear of passing out, losing control, or dying. "Many times people think they have a life-threatening illness," Ross says. "About a third of those who go to the ER for a heart attack are actually having a panic attack."

While the episodes are emotionally intense, Ross tells WebMD that they aren't physically harmful and pass quickly, usually within a few minutes. But the confusion and the embarrassment of being out of control can delay diagnosis, allowing phobias, depression, and self-medicating substance abuse to take hold, says Ross. Job performance, relationships, and just about every other aspect of life can be affected.

Breaking free of fear

The first step to recovery is an accurate diagnosis, Weinstock says. Often those with panic attacks also have depression and other anxiety disorders, all of which must be addressed. Treatment may include medication, therapy, or a combination of both. "There is hope," she says. "People need to know that they can get better."

John, now 26, agrees. Within a week of starting Paxil (different doctors may prescribe other medicines), his attacks subsided. "I take half a pill every night, almost like a vitamin," he says. "I don't have any side effects. It works for me." He also found a job that didn't involve travel, avoids smoking and drinking, and tries to keep stress levels in check. "I'm convinced that my lifestyle and the stress of my job contributed a lot to the panic," he says.

Others find that cognitive (changing one's emotional reactions) and behavioral (changing or "unlearning" self-defeating habits) therapy methods can desensitize them to the point that panic attacks lose their terror. "You have to be open to what works for you," says Ross. "And make sure your health professional is open to all options, too. We can't predict what will work best for each patient." Sometimes it is a process of trial and error, an individually tailored regime of medication, therapy, or both. "You should start to feel better within six weeks of starting treatment. If not, it's time to try something else," she says.

Treatment options improving

"The situation is much more hopeful now than even just 10 years ago," says Weinstock. "There are exciting possibilities for recovery, and they just keep getting better and better." Healthcare providers and the public have a better understanding of this illness thanks to awareness campaigns, she says, so much of the shame and stigma around this illness is dissipating as well.

Guardino hopes others struggling with panic won't wait as long as she did. "Panic disorder is a real, treatable illness. You can get treatment and your life can get better," she says. "You can take on the challenge of life without this extra baggage. Your world can be bigger."

Michele Bloomquist is a freelance writer based in Brush Prairie, Wash. She writes frequently about consumer health.

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